Panic attacks. Taking many meds. Can I take a Xanax?
March 14, 2016 5:50 PM   Subscribe

I have many health problems and I am on a variety of prescription and OTC medications, the most notable being Ambien, Atenolol and Notriptyline. My girlfriend has some Xanax and swears by the stuff. I recognize there is some risk of interaction, but it is reasonably safe to take an occasional Xanax while I'm taking these other drugs? (More info follows.)

Due to intense worry about my health, I have been experiencing daily, ghastly panic attacks. I've asked my doctor about taking Xanax sometimes, but he keeps saying "at some point" we may get me off Notriptyline and try an anti-anxiety med. I'd rather not get off Notriptyline (it does help my depression) but I'm looking for something additional I can take when the panic gets out of control.

I will have a colectomy at some unspecified point in the near future, and my doctor says he doesn't want to complicate things with another drug in my system. While I'm waiting for the surgery I've developed rapidly progressing neurological symptoms, I'm having trouble walking and my hands are getting involved. That's all being investigated, but no real answers yet. I'm left in indefinite, semi-constant panic. The people at urgent care say they can't prescribe anything, and I'd have to see my doctor (who has no appointments until April) or go to the ER. I've been to the ER TOO MUCH recently and frankly can't face the prospect of going back yet again. I'm sick of begging for something that will take the edge off this panic, and I've got some freaking Xanax right here.

My meds are all apparently rather low doses. The other meds I'm taking are Omeprazole, Claratin and Tamsulosin.
posted by Ursula Hitler to Health & Fitness (15 answers total) 1 user marked this as a favorite
No. Go to the ER (sorry, I know you don't want to) if you can't manage the anxiety without medication, but I would not mix those meds.
posted by zutalors! at 5:54 PM on March 14, 2016 [2 favorites]

Ambien, Atenolol, Notriptyline, Omeprazole, and Tamulosin all have moderate interactions with Xanax according to the drug interraction tool. So, absolutely don't take the Xanax without a prescription. Better to be in the ER voluntarily to get assistance with the anxiety than end up there in an emergency as a result of a bad interraction.
posted by cecic at 6:02 PM on March 14, 2016 [2 favorites]

I take Omeprazole and Claritin and occasionally Zofran and occasionally Ativan, though I have tried Xanax. I personally wouldn't mix Xanax with the anti-depressant and the sleep aid because they're all brain chemical-y and such.

Plus, personally I react strongly to meds and half the lowest dose of xanax (half of .25mg) still made me feel really foggy and weird and therefore MORE panicked for about an hour or two until it wears down. Therefore I switched to Ativan after getting it in the ER and it was better. (Again, half of the smallest dose so .25mg). BUT even Ativan will make me feel really sleepy and out of it if I'm not super anxious when I take it - it's a fine line.

So yeah you don't mention the dosage but I would say that Xanax, Ativan etc, can be very very strong - depending on your body - and make you feel really weird and you should work with a doctor about it. Taking a medication in this way may lead to a worse panic attack or another emergency situation.

Solutions: Does your doctor do same-day appointments? Can you call your doctor or a doctor on-call for an RX? (You still will have to pick it up in person.) Have you told them you need this medication ASAP? Can you get on a wait-list for cancelled appointments? Can you see another doctor in the same practice/clinic/hospital sooner? Do you have another doctor even if they aren't your GP/Primary that can get you in sooner?

Otherwise, yeah, I'd head to an ER. Take some snacks and a phone charger. Tell them you're having panic attacks and need something ASAP and an RX to get you through to your next doctor's appointment. That way you'll be in the ER when taking something should it make you feel weird.

Other things include breathing exercises and comedy shows in the meantime. Dumb, I know. But trust me - I've been there and it does help to a degree. I'm also here to chit chat.
posted by Crystalinne at 6:03 PM on March 14, 2016 [1 favorite]

Unfortunately, if your doctor has said it's a bad idea, I think you have to abide by that. If it's not bad enough for the ER, can you call the doctor's office and ask to be on the cancellation list?

Your doctors may already have run this, or you may already be tracked, and I apologize if so -- but if it hasn't come up as a possibility yet, I'd ask about thyroiditis. Anxiety, tremor, and large-muscle weakness can be symptoms of thyroiditis, and beta-blockers (atenolol) can mask some of the other symptoms like high blood pressure and rapid pulse, so they may not have thought of it.

This sounds very stressful. Good luck!
posted by pie ninja at 6:09 PM on March 14, 2016

I've faced a colectomy, and I wouldn't wish that on anyone.

But I've also taken tranquilizers when my bowel's been bad. And one of the side effects they've had with me is even more delayed gastric emptying. So I woke up aspirating my own vomit. I'm going to say it's a big no-no for that reason.

I think that the gut has pretty much the most powerful ability of any organ to make you feel awful when it's gone wrong, so maybe take a little heart in that. And this seems too simple to mention, but drinking plenty of water is almost certain to make life easier for your gut. I tend to drink it out of a camelbak because that reduces any swallowing of air that I might do, and means I can trickle in 2 litres over half an hour without thinking.

Good luck.
posted by ambrosen at 6:18 PM on March 14, 2016 [1 favorite]

Step away from the Xanax please! Even if there were zero medication interactions, I'd beg you not to take this - it's addictive and causes physical dependence. This is a Pandora's box you really don't need to open right now with everything else going on.

If the nortryptyline isn't cutting it and you need better management for your anxiety because of the severe effects it's having on your life, you need to go back to your prescribing doc and press the issue. "Don't want to have another drug in your system because at some point you're going to have a colectomy" is very vague. People with a list of meds as long as your arm still have colectomies every day, trust me. Maybe they thought you were demanding a benzo and were trying to mollify you, I don't know - make it clear you are willing to try other medications that are not habit forming.

I don't see why you would need to get off a psychiatric medication that's working for your depression to try something for your anxiety, so if that's a sticking point, get a second opinion. It sounds like this is taking over your life, and at some point your sanity is far more important than some theoretical impact a new med might have on your gut, even if it means you get on benzos for the short term - but they have to be prescribed to you by a physician who knows your health.

Also, I'm absolutely not saying that your neurological symptoms are not serious, I have no way of knowing what they might signify. But I urge you to consider that nonspecific symptoms that began during a very stressful time in your life (since planning for surgery began), when you admit that you are extremely anxious about your health and obsessing over it, could be related to stress - indeed I really hope that they are. Yes, get them fully checked out, but regardless, be careful of self talk around "I might be dying of some progressive neurologic disorder that no one can diagnose, so I might as well take this Xanax" themes. I'm not sure if that's how you meant your implication... that was how I took it. I hope this doesn't come off as mean because I really want to help you here. I remember many past questions of yours and I know this is a long term problem. Try to find new distractions and tell your girlfriend not to mention the Xanax and to put it away so you can get it off your mind.
posted by treehorn+bunny at 6:30 PM on March 14, 2016 [27 favorites]

Are different doctors prescribing these medications, is your GP up to speed on what all you're taking? Has a pharmacist gone over the whole list with you? Although you have every reason to be anxious (I'm pretty sure I would be, and I'm so sorry you're having to face all this!), I'm wondering whether you might be having adverse reactions to one or some of these meds, or their combination, and interpreting that as panic.

(I'm close to one person who had (apparently rare) adverse reactions to either tamsulosin or tamsulosin + the amitriptyline (also a tricyclic AD) he'd also been taking - cognitive issues, shaking, weird stuff. Tamsulosin on its own can cause low blood pressure, which can cause effects like these. Some of which resemble panic attacks, ime, anyway.)

Call your GP's office *every morning*, before 10 am* if you can (or if sleep is a problem and that's early, maybe your girlfriend can help with that), to ask if there have been any cancellations that day and/or if you can be put on a waitlist for an appointment. Even if there aren't any, within two weeks, the receptionist will eventually tire of the calls and make a spot for you, I bet. Failing that, go to the ER again. Maybe, see if a pharmacist will at least review your meds and go over possible side effects. So sorry you're having this to deal with.

*9 is really better :/
posted by cotton dress sock at 7:48 PM on March 14, 2016 [1 favorite]

The neurological stuff was very nearly it's own Ask, and probably should have been.

Back in the 90s I had all kinds of health stuff going on, including episodes of numbness in my left foot, left hand and left face. I think I had MRIs at the time (it's been a while and I've had a lot of tests over the years) and they didn't find any obvious cause. Eventually it went away. Then about 10 years ago I developed POTS. I had some tests and they never figured out what it was about, but they put me on Atenolol and that helped. A couple of years ago I had colon cancer, and they did a partial colectomy then and now they want to go in and take out the rest. While I've been waiting for that I was under a lot of stress, and about a month ago my body started going haywire.

It started with my feet turning very red when I stood or sat with my feet down, relieved when I put them up or walked. Then the numbness came back in my left foot, left hand and left face, worse than it had been way back when. Then my legs (mostly my right) became rubbery, so walking was pretty scary. Now my left arm is becoming rubbery, and my right arm seems to be catching up. I had a head and upper spine MRI and blood work, and they don't see signs of MS or anything obvious and they're not sure what this is. In the coming weeks I'm having another heart workup, a lower spine MRI and a nerve conduction study. While I wait it's just terror 24/7, and unfortunately all of my distraction techniques involve walking or using my hands.

For all I know this neurological stuff may all be anxiety, but frankly I doubt it. It may be drug interactions, but the fact that I had something similar 20 years ago makes that seem unlikely. (And I doubt the drugs are causing the panic. I think I'm just naturally panicking as I watch myself lose function in my limbs!)

I'm not gonna take the Xanax, and I thank you guys for convincing me. I'm either gonna go back to the ER or go to the urgent care and beg and plead for a prescription. I can't get a straight answer on whether they could write me one or not, but ANYTHING's better than more time in the ER.
posted by Ursula Hitler at 8:26 PM on March 14, 2016 [2 favorites]

I've had good luck taming my anxiety and panic issues with buspar. It's been around forever, isn't a benzo, isn't addictive, and plays nicely with most other medications. Since it can't be used as a recreational or high value trade drug, doctors are less likely to give you the stink eye, and the generics are super cheap. I just wanted to throw it out there for you to research and see if it might work with your other meds. Big hugs, I hope you feel better soon!
posted by SecretAgentSockpuppet at 9:12 PM on March 14, 2016

You need to call your doctor and be more forceful about getting another appointment. If it's causing you too much anxiety to call, ask your girlfriend to call for you. Tell the receptionist that it's extremely urgent and they need to give you an appointment. There is always room to squeeze someone in.
posted by radioamy at 11:14 PM on March 14, 2016 [1 favorite]

SecretAgentSockpuppet, does buspar work quickly for you? It sounds more like something you have to take every day to see the effects, and I'm really hoping for something I can just take as needed.

Radioamy, I have made a pest of myself at my doctor's office, believe me!

Thanks for the advice folks. I'm obviously under a ton of stress and I'm not coping well, and my questions don't seem to have simple answers. I very much appreciate your attempts to talk me through some of this stuff.
posted by Ursula Hitler at 2:17 AM on March 15, 2016

First of all, I just want to say that I've been through a similar period of intense, all consuming, always on the cusp of a panic attack anxiety, and it is so, so miserable. I'm really sorry you're dealing with this right now.

I agree with going to ER/Urgent Care in the short term, but in the long term, I would consider getting a second opinion if at all possible. If your doctor's response to "I have an unbearable anxiety" is basically to shrug and say that he doesn't want to add more meds, I think that's a major problem. It would be like a doctor not doing anything in response to a patient saying they have unbearable pain.

Now, some possibly relevant anecdata, although I am in no way, shape, or form a medical professional, so this is such personal experience:

I would not rule out anxiety as the cause of these neurological symptoms. I have been shocked, time and again, at what my anxiety can do to my body. For me, numbness and tingling in the extremities, which often got progressively worse. It got so bad in my feet at one point that I wasn't sure I could safely walk/drive. There were other symptoms as well, but the numbness is the one that stuck out in my mind the most.

I'm not in anyway discounting your symptoms, and it may very well be that your symptoms aren't caused by anxiety. It can be really hard to know, one way or the other.

Also, in talking with doctors about this, I would emphasize that you're willing to try any drug to help with anxiety, not necessarily a benzo. Personally, I've taken benzos in the past and am pretty wary of them. In particular ambien + xanax is not a great combo.

Last piece of anecdata: I'm a recovering alcoholic, so no benzos or other addictive meds for me. Also can't take SSRIs for other reasons. What has worked for me is clonidine. It's non addictive, and is a med that originally started as a blood pressure medication. I actually take it daily to help me relax at night to go to sleep, and I've taken the same dose for 5 years or so. I also take a smaller dose as needed for anxiety. I don't know how this would mix with your other meds (especially the beta blocker because of the blood pressure thing) or your other health conditions of course, but I just wanted to throw it out there. (I do mix clonidine with claritin and omeprazole daily.) At the very least, just know that there are other options.

Again, IANAD/IANYD, this is just personal experience. I really hope you find something to help you cope with this anxiety very, very soon. Hang in there!
posted by litera scripta manet at 9:18 AM on March 15, 2016

Have you considered hypnosis? I've seen a really good hypnotherapist do some amazing things and it might be a very effective way to reduce anxiety without using pharmaceudicals.
posted by metahawk at 10:00 AM on March 15, 2016 [1 favorite]

Update: Just got back from the urgent care, where a few of the doctors consulted on my case. Apparently almost anything they might prescribe had a substantial risk of interacting with the Nortriptyline, and Nortriptyline isn't something you can just abruptly stop taking, so it left me in a kind of catch-22. They prescribed some Lexapro and lowered my dose of Nortriptyline. I was really hoping for something I could take as-needed for panic, but unfortunately this is another drug I'll have to take every day. That's a lot of drugs in my system, but I've got to got my panic under control and if this works it'll be worth it.

Metahawk, I've been trying to get referred to see a hypnotist. I was certified as a hypnotist many years ago, and I know it can be effective. I downloaded some audio recording software and tonight I'm planning to try some self-hypnosis.
posted by Ursula Hitler at 8:16 PM on March 15, 2016 [1 favorite]

I'm updating on this just in case somebody else is looking for a fast-acting anti-anxiety drug, and they want to try Lexapro. About an hour after I took it the first time I suddenly felt hazy in a not-unpleasant way, and my anxiety seemed quite reduced. I haven't felt foggy when I've taken it since then, and if my anxiety has reduced it's kind of a subtle thing. I still feel more anxious than I'd like, but I haven't had a full panic attack lately and maybe this level of stress reduction is the best I can hope for given my situation.

So, TLDR: I think it's doing something, but it's not the magic, fast-acting anxiety relief I'd hoped for.
posted by Ursula Hitler at 12:01 AM on March 21, 2016 [1 favorite]

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